The only reason workcover case managers are employed is to help the Agent (aka the insurance company) to make money, or save money – as that is what all insurance companies do. They wouldn’t be in the business of providing “workcover insurance” to employers if they weren’t a business. The whole idea is to make profits. Period. Below are a couple of their most common “dirty” tactics.
Here are just four Court cases (and there are thousands) which sum up the dirty tactics used by workcover insurer, mainly via their workcover case managers.
(128)…Secondly, there was the delay in the proper calculation as to pre-injury average weekly earnings which placed him under financial strain for some time. (129) Thirdly, his weekly payments and reasonable medical and like expenses were wrongly terminated on the basis of a typographical error in a GP’s request for an ultrasound. It took some time for this to be rectified and his benefits reinstated, if only for a period prior to being terminated again. (130) Fourthly, the later termination (the subject of these proceedings)has meant that he has been placed under further financial pressure, been unable to continue medical and physiotherapy treatment and get access to rehabilitation or vocational assistance programs. (131). Mr H, the psychologist, has only considered PTSD in his treatment in this case. He considers the dealings by the employer and the authorised agent as being the major reason for what he refers to as the “exacerbation” of the PTSD…
93. Second, the general conduct of this matter has been seriously alarming. Notwithstanding Dr Casikar’s opinion, his report provided no proper basis for Allianz, viewing the matter objectively and fairly, to deny the claim. A fair reading of the history of the claim demonstrates a perfectly consistent story corroborated by complaints to first aid and strongly supported by all the treating doctors and by several objective investigations, namely, a CT scan, MRI scan and a positive discogram. Allianz had no proper reason for denying liability and should not have done so.
94. Third, it is apparent that, notwithstanding the admissions made by Mr Taylor at the arbitration, Allianz has not paid the weekly compensation awarded to Mr Fogarty and has thwarted his attempts to have the surgery recommended by four specialists. Allianz is a fund manager under the NSW workers’ compensation scheme. It would (or should) have been well aware of its obligation to pay an award of the Commission for the payment of weekly compensation, which obligation continues notwithstanding the filing of an appeal under s 352. Its failure to do so in the present case is reprehensible and will be referred to the WorkCover Authority of NSW for investigation
95. Fourth, Allianz’s behaviour is all the more disgraceful given that it is obliged to act as a model litigant. That means more than acting honestly and in accordance with court rules, and more than lawyers acting in accordance with ethical obligations; it must be a “moral exemplar” (State of Queensland v Allen  QCA 311 at –; LVR (WA) Pty Ltd v Administrative Appeals Tribunal  FCAFC 90 at , , and –). It is obliged to pay legitimate claims without litigation. Mr Fogarty’s claim was, without doubt, a legitimate claim that should have been paid without the need for litigation. Why it was not paid should also be investigated.
In this horrid case, an injured worker had, according to the Judge, “good reason” to feel harassed by the insurers (Allianz NSW) who managed her compensation claim. A NSW court has ruled in finding her anxiety and stress were work-related. The Workers Compensation Commission, Deputy President Bill Roche heard the worker had suffered chronic pain, insomnia, anxiety, social withdrawal and depression as a result of her physical injuries and the claims process.
An extract from the court case (transcript) which is publicly available reads as follows:
“Ms Davis (plaintiff) spoke to Ms Reiner’s manager, Ms Rogers, and contacted WorkCover. She felt that the approach by Ms Reiner and Ms Rogers was unprofessional and constituted bullying and victimisation”.
“Following the exercise physiologist’s report, an officer from Allianz, Ms Reiner, telephoned Ms Davis, which made her angry and distressed “because of her thinking that she could intimidate me”.
“Ms Reiner said that Allianz was aware that Ms Davis had an injury, but they did not think it was as bad as had been reported. She said that Allianz had video surveillance of Ms Davis and reports of her carrying out a number of activities. Ms Davis did not deny having carried her daughter’s school backpack over her right shoulder, using exercise equipment in the park (with no weight or resistance), and being able to walk. Ms Davis was further distressed when Ms Reiner threatened her when she said that fraud was against the law. She felt frustrated when she saw what had been reported because of the surveillance”
Ms Davis said she felt it was unreasonable for Dr Kafataris to expect her to increase her hours of work and that it was “more of the bullying tactics” that were being directed towards her by Allianz. She felt that Ms Reiner had bullied her by sending her job seeker diaries even though she had been certified unfit
The day after Ms Davis received the surveillance report in the mail from Allianz, she experienced two significant panic attacks and a third attack on 3 November 2008 when she listened to voicemail messages from Ms Burgess. She felt that Allianz, through its letters and “bullying telephone calls”, was sabotaging her attempt to get on with her life. She felt that Allianz was treating her unfairly, and disguising their treatment of her by talking about the Workers Compensation Act caused her distress”
“She [plaintiff] described her experience dealing with Allianz (NSW) staff as being bullied by a global organisation…”
- First, they make the same basic error referred to above under “psychological injury”. The worker did not suffer a “psychological injury” and her counsel did not argue that she had. It was therefore not necessary for the Arbitrator to find injury under s 4 and that employment had been a substantial contributing factor to any psychological injury. The Arbitrator erred in finding that the worker had received a psychological injury. However, applying the correct approach, the conclusion is the same. Ms Davis’s psychological condition resulted from her physical injuries. Her symptoms (from her physical and psychological conditions) resulted in her being totally unfit from 30 October 2008 to 30 April 2009 and partially unfit thereafter.
- Second, Ms Davis’s psychological symptoms developed in 2005, not 2008, and the evidence from Ms Marshell clearly linked those symptoms to her physical injuries and the claim for compensation for those injuries. The management of a claim for compensation is as much a part of the claim as the treatment of the injury.
- The worker was a truck driver. He injured his back on 30 July 1981 while climbing up and down from his truck. He stopped work in June 1983. In September 1985, his general practitioner, Dr Furey, reported that the worker was:
“very distressed because of the delay in reaching a solution to his back difficulty. He felt that, if he did anything, people might be watching him. He was very upset. He was complaining of a knot in the stomach. He was depressed and he was placed on a tranquilliser.” (at 453-4)
- In May 1986, Dr Furey described the worker as “very severely depressed”. His personality was being affected by the “chronicity of his condition”. In July 1987, Dr Furey advised the worker to go on a diet as his weight had increased because of his inactivity. In April 1988, the worker told Dr Furey that he had a lot of suicidal thoughts. Dr Furey felt that the length of time in the compensation system was the “root cause of all this”. In March 1989, the worker’s back continued to give him excessive pain, radiating down his leg.
- In March 1991, the worker was again found to be “excessively depressed, anxious, still having problems at home and problems with his back”. He had a sudden, unexplained exacerbation of pain in November 1991. A CT scan on 6 November 1991 revealed degenerative disc disease, with a prolapse at L4/5 and significant degeneration at L5/S1. There had been a gross deterioration since the scan taken in April 1982.
- On 16 March 1992, the worker received a letter from the insurer advising that compensation payments would cease from 29 March 1992. The worker saw Dr Furey on 19 May 1992 severely depressed. He said he did not have enough money to pay the doctor and that he would have to sell his house. He was worried and anxious about his future. On 8 June 1992, the worker died of a heart attack.
- Dr Furey stated that, while the worker had antecedent myocardial disease, it was exacerbated by the “depressive and anxiety situation in which he found himself, as a result of the lengthy and protracted workers’ compensation situation”. He felt that the worker’s death had been accelerated by the “stress generated by the cessation of compensation payments and the peculiarities of the workers’ compensation system”. The heart attack had happened much earlier than the worker should have had it and was “totally related to his back injury and the failure to reach a satisfactory conclusion within a ten year period”.
- The worker’s widow made a claim for compensation benefits, which the insurer denied. She relied on evidence from Dr Furey and Dr Schiller, physician, who concluded that the emotional stress and depression the worker experienced in the weeks leading up to his death, which resulted from the cessation of compensation payments and consequent financial crisis in which he found himself, contributed to his death from a heart attack. Dr Schiller added that the worker’s sedentary lifestyle due to his back injury and unemployment also contributed to the heart attack. The employer called no evidence.
- The test of causation in a claim for death benefits under the 1987 Act is the same as in a claim for weekly compensation: if the death “results from an injury”, compensation is payable (s 25 of the 1987 Act).
- The trial judge found that the deceased “suffered injury in the course of his employment on 30 July 1981; namely, injury to his lower back” (emphasis added) and that “[a]s a result thereof the deceased suffered myocardial infarction from the effects of which, on 8 June 1992, he died” (at 457E). The judge did not find that the worker suffered a psychological injury or that the heart attack was a personal injury.
- The employer appealed. It argued that the prolonged incapacity, immobility, sedentary lifestyle, increased obesity, stress and anxiety, depression, and acute stress when compensation payments ceased were all “mere predisposing factors” that were not “causative in the relevant sense that it was not shown that the death ‘resulted from’ any of them, either individually or in conjunction” (at 460F).
- Kirby P (as his Honour then was) said (at 461G) (Sheller and Powell JJA agreeing) that “[f]rom the earliest days of compensation legislation, it has been recognised that causation is not always direct and immediate”. After referring to earlier English authorities, his Honour added (at 462E):
“Since that time, it has been well recognised in this jurisdiction that an injury can set in train a series of events. If the chain is unbroken and provides the relevant causative explanation of the incapacity or death from which the claim comes, it will be open to the Compensation Court to award compensation under the Act.”
- His Honour said at 463-4:
“The result of the cases is that each case where causation is in issue in a workers’ compensation claim, must be determined on its own facts. Whether death or incapacity results from a relevant work injury is a question of fact. The importation of notions of proximate cause by the use of the phrase ‘results from’, is not now accepted. By the same token, the mere proof that certain events occurred which predisposed a worker to subsequent injury or death, will not, of itself, be sufficient to establish that such incapacity or death ‘results from’ a work injury. What is required is a commonsense evaluation of the causal chain. As the early cases demonstrate, the mere passage of time between a work incident and subsequent incapacity or death, is not determinative of the entitlement to compensation. In each case, the question whether the incapacity or death ‘results from’ the impugned work injury (or in the event of a disease, the relevant aggravation of the disease), is a question of fact to be determined on the basis of the evidence, including, where applicable, expert opinions. Applying the second principle which Hart and Honoré identify, a point will sometimes be reached where the link in the chain of causation becomes so attenuated that, for legal purposes, it will be held that the causative connection has been snapped. This may be explained in terms of the happening of a novus actus. Or it may be explained in terms of want of sufficient connection. But in each case, the judge deciding the matter, will do well to return, as McHugh JA advised, to the statutory formula and to ask the question whether the disputed incapacity or death ‘resulted from’ the work injury which is impugned.”
- His Honour concluded that the Court was left with “an unbroken chain of undisputed evidence”. In combination, the facts went “beyond mere predisposing circumstances”. They combined to make it “proper to reach the conclusion that the death of the worker ‘resulted from’ his original injury and all of the consequences which it set in train”.
Learn about the Workcover case manager
The workcover Case Manager is simply your representative of the workcover insurance company, also known as the workcover Agents (eg. Allianz, CGU, EML, Gallagher Basset, Xchanging) that communicates directly with you in the first instance. They “manage your workcover claim”, and regularly change as well. In some other countries, Case Managers are called “Adjusters”. If you think about this, simply the term “adjuster” means that their job is to “adjust” your workcover claim costs to save as much money as possible.
1. WorkCover Case Managers try to save or make money by managing your workcover claim
There are several ways your case manager will try and save or make money for its employer – The Agent (workcover insurer).
The most common tactic to save or make money for the Agent (insurer) is by trying to delay and deny your legitimate workcover claim in the first place. Although case managers (and the like) often do not have any appropriate qualifications,(eg. worked at Pizza Hut, KFC, Dancer etc.) they are alleged to receive a 2-week in-house training course where they essentially learn how to minimise the benefits you should get. This can include weekly pay, and medical and like treatment. Think about it, the less rightful workcover benefits you receive, the more they save money and allow their employer (insurance agent) to make money, profits for the insurer and their shareholders. If that’s not bad enough, workcover insurers also financially reward case managers for saving money (by denying or minimising benefits)!
Many WorkCover Case Managers are also overworked and manage allegedly 200 workcover claim each, so it can be hard to get in touch with them, and most don’t even know who you are and what you have gone through or are going through. In fact, you are just a number – that’s the reason why, when you contact your case manager, you have to give your claim number (no name!)
It’s very important to understand that workcover case managers are NOT your friend (ever), even if they pretend to “care” about you. Some will go as far as to pretend they are your friend and convince you of inappropriate things such as “you don’t need to see a clinical psychologist… you can talk to me”.
2. Common deceitful tactics of workcover case managers
Here is a list of the most common ‘dirty’ tactics used by workcover case managers:
- Misrepresenting the FULL workcover benefits you can receive as an injured or ill worker under the workcover law – this is a huge one. Because workcover case managers know many injured workers don’t have a lawyer (certainly not in the beginning), they make it seem like you can’t get certain benefits when they know you can, or they never tell you about the workcover benefits you are entitled to.
- Protecting you (the injured worker) and providing for you (and your family) IS NOT the workcover agent’s and it’s case managers’ job. Providing you with the much-needed education about the workcover law in your state and the benefits you are entitled too IS NOT their problem. As an injured worker, you may not even know what to ask for, and they definitely won’t tell you. Examples include that they will not tell you that you can receive home help, garden help, have reasonable changes/modifications made to your home or car, receive assistive and ergonomic devices/tools (eg. shower stool, bath rail, electric can opener, etc) that you can obtain taxi travel to and from medical appointments, that all your medication for your injury can be reimbursed, that you are totally entitled to seek treatment in a private hospital, even attend a private hospital emergency department. So it is very important that you look up the workcover authority website in your state (eg. Worksafe Vic for Victoria) and actually read all you can to begin to understand what you are entitled to. You really need to know what you’re entitled to and how to obtain it.
- Workcover Case Managers will deliberately not return your calls or emails – Not hearing back? Called 20 times? Still not hearing back? emailed 3 times, still no response? It’s a common dirty tactic to make you totally frustrated. They do this for the sole purpose to delay and deny your medical treatment and other benefits. Sometimes they will acknowledge or reply to an email but mislead you, or stall the answer by stating things like “I have just requested further information/clarification from your treating doctor…” But in actual fact never did even request it! We highly advise all injured workers to only communicate in WRITING with their case manager(s), email is fine. At least that way you have a RECORD, and can refer to previous correspondence. There are some apps that allow you to obtain a read receipt, and we highly recommend this too so that they common excuses of “not having received your email etc” does not stand. If that doesn’t work, by all means, cc your lawyer/law firm into the email, or even the Ombudsman. If things are just out of hand and extremely frustrating/stressful, please direct your case manager – in writing – to only correspond with your treating doctor (GP, Psych, anybody), or your lawyer!
- Advising you not to get a lawyer – this one we see so often and can be the most damaging too! If you have a more serious injury (eg more than a simple sprain or simple broken arm) it makes it a lot easier for your case manager to take advantage of you if they know you don’t know the applicable workcover law and don’t know what benefits you are entitled to, and how much “settlement”you deserve. Your case manager will NOT give all you rightfully deserve under the workcover law if you don’t have a lawyer. Again, this can be anything from not informing you that you can dispute a permanent impairment assessment by an IME, it could be ceasing your entitled weekly pay for no valid reason, denying you treatment etc. We always recommend that any more seriously injured worker engages a no win no fee lawyer as soon as possible. We highly recommend Zaparas lawyers.
- Workcover case managers will insist to speak with your doctor, or worse, insist they attend your appointment! This is a NO-NO! We so often hear from injured workers that their workcover case manager often calls their treating doctors and even their treating specialists (i.e. specialised surgeons, specialised pain doctors, psychiatrists etc). We also hear a lot from injured workers in states that appoint “nurse case managers”, that they insist on attending injured workers’ medical appointments, claiming they have the injured worker’s “best” interest at heart. Many ignorant injured workers also allow their rehab service provider to attend their medical appointments. Injured workers should never ever allow this! Because the case manager does this to influence and pressure your treating doctor(s) to force you to return to work (prematurely), downgrade your injury, even change the description of your injury and go as far as pressure them to change your medication or medical treatment plan. Simply tell your treating doctors (i.e. GP, Surgeon, Pain doctor, Psychologist, Psychiatrist, Physio etc) that you feel it is a violation of your PRIVATE doctor-patient relationship. Also, make sure you write a letter to your case manager requesting s/he explicitly refrains from contacting your treating doctors by telephone, and that you refuse anybody from the insurance company (i.e nurse case manager, rehab provider) to attend your medical examinations/appointments, highlighting privacy breach.
Now that you know some of the common dirty tactics, tricks and strategies workcover case managers use against you, we hope you will be ready for them. You may not realise it, but your case manager is only there to work AGAINST you literally from the moment you get injured at work. Don’t get fooled, don’t make these mistakes! If you’ve been more seriously injured or made ill at work, get all the information you can before trying to handle or manage your claim by yourself. Best is to engage a good personal injury lawyer with expertise in workcover.
The best way to protect yourself is to know the workcover system, and have someone fighting on your side!
3. The role of the all-mighty, non-medically trained workcover case manager
We all know by now that Workcover case managers come in many different shapes, sizes and – especially- characters. They can be young and extremely inexperienced, lacking communication and basic people skills; many are in their forties, divorced and utterly miserable sourpusses, some are male, most are female, some have years of experience and have undoubtedly gone through a “work hardening programme”, some are fresh off the street and so inexperienced and non-educated in the law and in medical terminology it’s frightening, many are, yes, lazy and incompetent, a very few are decent. They are pro-active and re-active case managers. Most don’t give a hoot about the plight of the injured workers, and -perhaps most importantly -and the most frightening part, as most of you know, is that it is our medically untrained, totally uneducated workcover
Case Managers clerks are allowed to make that life or death decision for us, by over-ruling. How cool is that! They actually get to play God!
“…Advice from the most senior Medical Staff in the country can be overruled by Case Managers, and often Orthopaedic or Neurosurgery is delayed or never done on the whim of a Case Manager “who decides that it is not necessary.”The Case Managers, employed by the Insurer, and the Return to Work Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge…”
[Professional Health Partners P/L stated in their submission re the NSW workcover overhaul the classic statement of facts]
You don’t believe us? Well check out the statement made on workcover SA’s website for example entitled: the workcover case manager:
The case manager is responsible for deciding if the claim can be accepted for compensation under the legislation. The case manager will work with the injured worker (since when?), employer, health provider(s) and rehabilitation provider to coordinate the return to work process.
Their role includes – and please read and re-read between the lines for it is all there:
- case managing the claim from an administrative, cost and legislative perspective
- developing and approving programs and plans in consultation with all parties
- ensuring information provided to injured workers about their rights and responsibilities is made available in a language or format suitable for the worker
- assessing the requirement for workplace rehabilitation intervention through consultation with the worker, employer and treating doctor
- determining the rehabilitation and return to work objective and goal(s) for the worker if required
- selecting a rehabilitation service provider to provide user services
- assessing the requirement for medical expert and other support services in consultation with the workplace rehabilitation consultant and treating medical practitioner
- reviewing programs and/or plans to ensure they are progressing towards the identified objective and goal.
What does this say to you? Yep: the workcover case manager has TOTAL control over you, the injured worker – even though s/he has never ever seen you, has no medical or allied health knowledge, is not a doctor, not a “rehabber”, and is just a “clerk” really! How bloody frightening is this?
Add to that the fact that all insurers we know of usually have an incentive or bonus program (for case managers) tied to the reducing the number of workcover claims or reducing the benefits paid to legitimately injured workers, even the most seriously injured amongst us… and yes, it is a recipe for disaster. And so it is that many case managers primary goal is to focus solely on finding an excuse or basis for denial or delay of legit benefits to the injured worker (i.e. surgery, weekly pay, home help, physio, hydro, pain management, counselling etc).
4. Red Flags for the workcover case manager
It is well known that WorkCover Case Managers (or Claims Managers) will be very quick to red-flag injured workers. Whenever something happens that is a little different, it raises an immediate red flag for the WorkCover insurance company (and your case manager)! The main issue is, is that once that red flag has been raised, it is very difficult to get it lowered again. Bing red-flagged causes a myriad of problems in obtaining prompt approval for medical and like treatment and other benefits. It also causes the use of surveillance and, most importantly, it will cause a general, adversarial stubbornness to resolve any part of your WorkCover claim without a big fight.
4.1 Red flagging injured workers by WorkCover
Red flags of a bogus workcover claim – can you spot them?
We stumbled upon a bizarre and utterly narrow-minded write-up by a large workers comp insurance company (name omitted for obvious reasons) featuring a “sample workcover claim” to “assist case managers to recognise the bogus workcover claims”, which are, of course so rampant… Really?
The presented workcover claim:
Mr Smith works in an auto repair shop as a mechanic. Upon arriving early for work on a Monday morning, Mr Smith went into the auto parts storeroom to get a part for the car he was going to work on. While leaving the storeroom and using both hands to carry the heavy auto part in a box, he tripped over another box on the floor. In an effort to keep from falling, he grabbed a storage shelf, twisting and injuring his shoulder as he fell to the floor. No one saw him fall in the parts storage room as the other employees were just arriving for work.
Mr Smith immediately reported the claim to the shop manager and explained to the manager how he fell over the box on the floor he did not see because of the box he was carrying with both hands. The shop manager offered to take Mr Smith to the nearest occupational medicine clinic, but Mr Smith instead chose to take himself to his “family doctor”. The family doctor took Mr Smith off work and did not indicate when he would be able to return to work.
When the shop manager called Mr Smith the next morning to see how he was doing, Mr Smith’s wife stated he was sleeping and could be disturbed. The shop manager waited and called Mr Smith again that afternoon. Per the wife, Mr Smith had gone out. The shop manager asked for Mr Smith’s cell phone number, but instead of providing the phone number, the wife promised to have Mr Smith call the manager. Mr. smith almost immediately called the manager back to relay what the family doctor had said. The shop manager recorded the cell phone number of Mr. smith. When the shop manager called Mr Smith’s cell phone the following week to see what the family doctor had to say after the second medical appointment, the background noises did not sound like the noise you would hear in a person’s home.
A second mechanic in the shop after being overworked for three weeks due to the absence of Mr Smith advised the shop manager that he had heard through a mutual friend that Mr Smith had injured his shoulder while rock climbing the weekend before the reported injury…. [Oh really?]
The claim apparently has numerous red flags that could be a tip-off for fraud!
- A Monday morning accident. Almost twice as many accidents occur on Monday morning than any other morning of the week. This is due to people claiming non-work related weekend injuries as work-related in order to not lose their source of income…. Oh dear, oh dear
- Arriving early for work. Unless the employee habitually arrives early for work, arrival for work early on the day of the alleged accident is an indicator the employee wanted to “have the accident” before other employees see he is injured. Oh really, Jeez!
- Not seeing a hazard he had just saw moments earlier. If boxes on the floor were a common occurrence, the employee would be careful about watching where he was going. If a box on the floor was unusual, the employee would have made a mental note to avoid it. Oh my God!
- The mechanism of injury does not make sense. If the employee was using both hands to carry a heavy box, how did he have a hand free to grab the storage shelf? Oh dear… never heard of a reflex?
- The accident was not witnessed. Bogus injury claims almost always occur where no one else will see the accident happen. Oh my God, how narrow-minded!
- The selection of a particular doctor over a more qualified doctor who specialises in treating injured employees. This is normally a sign the employee wants a doctor who will accommodate his desire to be off work.
- A doctor who does not address return to work. This is normally because the injured employee tells the doctor that he does not feel he will be able to meet his job requirements. OM(F)G! Isn’t there a thing called “unsure when the patient will be fit to resume duties?” Duhhh!
- The employee being asleep when he would normally be awake. Unless the doctor has prescribed some very strong pain killers, the employee should be available to talk to the employer. Arrrrgggg!!!!!
- The employee not being at home. Occasionally not home is understandable, repeatedly not home/not available is usually a sign the employee has something better to do than being at home, i.e., possibly another job, either short-term or long-term. Background noises that don’t sound like a spouse or a television often are an indicator the employee is working elsewhere. OOOOOOOOHHHHH!
- Tips from -DISGRUNTLED-co-workers. This is probably the strongest evidence of fraud and should be investigated thoroughly
What can we say to this kind of “lectures”? Is it a wonder 95% of all genuine work injuries are initially knocked back?
So, please rock up for work late, if you break a leg don’t do it on Monday, make sure you chain yourself to a colleague at all times so you have a witness just in case, don’t try to recover in bed when seriously injured (don’t sleep during the day even though you may not sleep all night due to severe pain), don’t leave the house, have a police man put a house arrest bracelet on you so you have evidence, actually best would be to check into a high security jail when you have been injured at work (you are treated like a criminal in any case), please don’t trust your own treating doctor whom you have seen for yonks (but go see someone who you have never seen for treatment and opinion of your injury), call your case manager each time you need to leave the house, i.e. to go to the pharmacy, but make sure you call from the toilet seat so there is no “strange background noise, hey”.
We’re STUNNED that this is the kind of CR#P they teach our already medically uneducated workcover
clerks case managers. Honestly!
4.2 Tips to reduce the chances that you will be red-flagged by the WorkCover insurance company
There are a couple of things you can do to decrease the chance that WorkCover will red-flag your claim – that is label it for increased scrutiny. These include:
- Report your injury immediately. If you don’t, they may think you injured yourself outside of work (e.g. injured on Friday but reported on Monday will raise a flag and they will assume you injured yourself over the weekend, at home)
- After you have been injured, seek immediate medical treatment and ensure you tell the doctor (or the hospital) exactly HOW you were injured WHILE WORKING.
- Please don’t call your WorkCover case manager, yell, scream, threaten, swear etc. No matter how angry and frustrated you are and no matter how justified it is! The same applies to emails or letters, never use coarse language, never threaten them and never write in CAPITAL LETTERS either! I once dictated a letter to my case manager and only used capital letters as I didn’t know how to set the settings on the dictation software. To my horror I received a nasty reply, threatening me with police action as they perceived capital letters to be rude and threatening! TRUE!
- Don’t miss any medical appointments with independent medical examiners or doctors, or service providers the insurance company has selected – for example, IMEs, Vocational Assessors, Rehabbers etc.
- If you have been prescribed physio (or something similar), please attend your appointments.
- Try to return to work as soon as possible and in any capacity, even 2 hours a day on alternative duties.
- Please don’t go doctor-shopping – don’t change doctors often.
- Please don’t over-treat. If hydro doesn’t help, don’t keep going 3 x a week. Don’t abuse prescriptions, don’t get duplicate prescriptions from different doctors and definitely don’t lose your medication – they may accuse you of selling narcotics!
- Obviously don’t do anything stupid like working a second job while receiving workcover weekly payments.
- Try to cooperate as best you can with your WorkCover case manager, Vocational Assessor, Rehabber and your own Doctor etc. Try to attend all appointments.
- Never exaggerate. Never lie. To anybody. Including your doctor (not providing an accurate history of for example past injuries and current injuries); your lawyer (many problems can be dealt with by your lawyer if he knows about them in advance) etc.
- Never post anything on Social Media that you don’t want them to know about, or that can be taken out of context.
- Don’t talk about your claim – remember “loose lips sink ships”!
CONTROL WHAT IS IN YOUR POWER!
5.Things that annoy the sh*t out of WorkCover case managers
In this article, we cover yet another few “buzzwords” which are guaranteed to annoy the sh*t out of virtually any WorkCover case manager. The supposedly “lighthearted” (but true) content was provided to us via an informal interview with a former Allianz case manager… So here we go…
5.1 Fibbing about never having had an injury before
Apparently, according to the former Allianz WorkCover case manager, there is always some distrust between an injured worker and an insurance case manager at the beginning. The reason case managers are distrustful of a “claimant” is that they wrongfully believe that many injured workers are frauds and seeking nothing more than a “free holiday”. Many case managers also believe that quite a few injured workers “make a career of claiming workers compensation benefits”, “yes really”, says our insider! Many “claimants” also get off on the wrong foot with a case manager and this is understandable. Many are genuinely scared of the unknown and many injured workers have heard horror stories from other injured workers, and naturally, worry that they will not be entitled to certain benefits or that their claim will be rejected.
The former Allianz case manager also thinks that “most people feel that all WorkCover insurers “share” information on people. That is true to a point”. Case managers will – always -run through the “motions” and do an “initial but thorough background check with just about every claim they receive”. The insurer does this to protect itself against “fear of the unknown” – so they say – but in actual fact, they do so to find any way possible to reject liability and compensability for a workplace injury. “This is just part of the initial claim set up”, says the former case manager. “It’s about business”.
The former Allianz case manager also tells us that honesty is her best advice. “Just because you have had an injury that that particular body part, or that you happened to have had a previous workers compensation claim, does not necessarily mean that your claim will be doomed”. The problem is that “case managers are obliged and will snoop in your past medical history and conduct thorough background research on you”. “If they find injuries or claims in your background and you have not shared those with the case manager or the insurer, it will become a big beacon on the radar”.
“Rest assured that the case manager will go the distance in overturning every single rock they have to in order to feel they have completed a thorough investigation”.
Her advice is to be “honest” as best you can and to report all previous injuries, no matter how insignificant. That way, they can never ever “blame” the injured worker of “hiding something”.
“Case managers take it as a point of pride that the claims they pay are legitimate” if you know what I mean, says the former case manager.
5.2. Sighing and grunting on the phone (WTF)
According to our insider, nothing more annoys the sh*t out of an Allianz case manager than to sign, groan or moan on the phone whilst talking to a case manager (WTF). She says that many [evil] case managers do not understand what PAIN is and for example do not understand that “a serious laceration or a broken leg” can make you groan on the phone, especially when the said case manager is asking you to move about and sift through some paperwork, looking for “information” etc.
Many case managers will make fun of injured workers after a telephone call and state things such as “another one looking for an Oscar in pain performance”, ”Please do not drive the point home by being unable to complete a sentence without groaning in unbearable pain. I understand there is pain, but can a decent laceration, a bee sting, bruise, broken bone be that disabling? Sure everyone has their own pain threshold, and some people can deal with pain better than others deal, but again please just act f *cking normally. There are no Oscars for pain performance”!!!!!
What’s more, many case managers will deliberately sift through an injured worker’s medical reports to see whether a doctor or even an IME has, in fact, indicated that the pain is in proportion to the injury! If the notes indicate that the pain (as in groaning, moaning, etc) appears out of proportion (i.e the so-called Waddel signs), the case managers will believe that the injured worker “is over the top” and will be less likely to believe an injured worker. You will then be flagged as a “malingerer”, she says!
5.3. Demanding 24/7 medical attendant care
Fact is that insurers and as such case managers prefer – at all cost – to use the husband or wife as a carer for assistance with activities of daily living. Even WorkSafe Vic has guidelines about the provision of, for example, home help, whereby it insists that the husband/wife must take care of the injured worker and for free! Obviously, case managers will go to great lengths to exploit the use (abuse) of the spouse as a carer, instead of bringing in outside vendor and person to do this work for them, at a cost (labour).”Much cheaper that way”, says our insider.
Some injured workers will, understandably, argue that it is not up to their full time working spouses to care for them (as a free carer) and to undertake all the household work as well as the personal care for the injured worker. Especially, given that most injured workers were, in fact, doing those duties (or part thereof) prior to their injuries.
According to the former Allianz case manager, “nothing will irritate the case manager more than receiving an account for 24 hrs per day, 7 days per week attendant care”. Obviously, this is not reasonable or acceptable. But, saying that we believe that the spouse should not be made responsible to be made the sole non-paid carer (cleaner + attendant) for an injured spouse!
Also, according to our insider, “some injured workers will demand more home help or attendant care than they should in the view of uneducated case managers”. “The more the issue is pushed, the more of a red flag the case manager will raise that there are some secondary gain issues going on”. WTF!!!
Most case managers believe that if you are not a quadriplegic, you should be able to “care for yourself” or “made to care for yourself” with things such as long-handled toilet brushes, a light hoover, and a long-handled bathroom scrubber!
5.4. Lying about transport or kilometres to be reimbursed
Case managers will go ape when an injured worker is travelling 50 kilometres to go to a physio or rehab facility (whatever). Apparently, if an injured worker travels more than about 20 kilometres, the case manager will see that as a red flag and cause more surveillance – WTF!
We just wonder about those injured workers living in remote or rural areas, and even those who live in cities but who are in need of specialist centres of a decent doctor, therapist, etc! How sick to judge an injured worker on mileage travelled!
5.5. Being a “Google doctor”
More and more injured workers, understandably, will “Google” their injury and try and find out as much as they can about their type of injury, treatment and so forth.
Our insider tells us that case managers hate it when injured workers use medical terms or “talk shop” with the case manager (WTF!). Case managers feel very upset when injured workers do so, because “case managers have handled claims like yours for years and they think they know the time-frame and the improvement step to make and when they should be made” – wow, how SICK!
Any deviation from that timeline template raises the red flag and a watchful eye, says our former case manager!
So again instead of this helping the scenario, it is hurting it in the long run. … WTF!
No wonder I have being treated like sh*t the minute I have talked or written about my medical condition, complications or prognosis (and I am medically trained)! And as if my uneducated case manager would know anything about the injury I suffer, hell, even my upper limb specialists has not seen this before. One of the operations he performed on me had only been done once before!!!! And that bitch even had the guts to tell my upper limb specialists that “she did not believe him and that I needed an objective medical examination”! Guess what, the objective examination consisted of an 8o-year-old (at least) GENERAL surgeon’s old fashioned and clue-less opinion on a mangled arm. A limb that this geezer has never ever operated on either by the way, as he deals with gall bladders, warts and stuff like that. Still, his honourable “opinion” was in my favour and far much worse prognosis was given, inevitably, given that he knew nothing about bionics.
5.6. Other irritants
According to our insider, there are other important words that annoy the cr*p out of case managers, and these are so-called “risk” or “risk drivers”. These are the non-injury facts that can contribute to disability and include things like obesity, diabetes, having a young child at home (being off of work decreases daycare costs), not wanting to go back to work in general, pending layoffs at the employer of the injured, smoking, etc. (WTF).
Our insider tells us that for example, if an injured worker is “fat”, the case manager will go to great length to try and blame the injury and consequences on being “fat”, rather than the other way around (fact is many injured workers will gain weight because they lose their job, hobbies, activities, etc). While some risk drivers may (MAY) have a bearing on a claim (i.e drug/alcohol use), most are RIDICULOUS.
So there it is… words and issues that annoy the sh*t out of case managers. These will never go away, and will probably increase in use as time goes on, says the former Allianz case manager. The system is heavily biased, and that is why I chose to leave and ran as fast and as far as I possibly could.
6. Standards of Practice for workcover insurer case managers
Workcover case managers are -supposedly- bound by Standards of Practice. These can be summarised as follows:
- The workcover Case Manager must operate only within the context and boundaries of his/her educational achievements and earned credentials
- The workcover Case Manager must disclose educational qualifications and professional credentials to clients when required
- The workcover Case Manager is to maintain knowledge of and practice within laws, regulations and policies implicated in their practice
- The workcover Case Manager will endeavour to strive for best practice in their work, in line with the National Standards of Practice for Case Management
- The workcover Case Manager will maintain their professional development in areas of expertise
- The workcover Case Manager will not provide services where they are aware of a conflict of interest
- The workcover Case Manager will not accept gratuities, rebates, bonuses, gifts or other remuneration outside of their usual employment arrangements
- Case Managers must seek guidance from their agency regarding potentially unethical requests or situations
- The workcover Case Manager must seek guidance from their agency when dealing with any legal concerns
- The Case Manager must always gain informed consent, including the provision of information for purposes of research
- The workcover Case Manager must advise clients of their rights prior to them agreeing to accept a case management service
- The workcover Case Manager must fully disclose fees prior to carrying out services
- The workcover Case Manager will respect peoples right to be an individual and refrain from value judgments
- The Case Manager will respect a person’s right to self-determination and the right to live with risk so long as there is no harm to themselves or others
- The workcover Case Manager needs to ensure clients are fully informed of services available to them
- Each individual must operate without discrimination or harassment to others
- The Case Manager will not be involved in any sexual relations with clients or their carers
- The Case Manager will consider the best interests of the client as paramount at all times
- The workcover Case Manager must respect the policy and procedures of their employer
- more information about standards can be found here: Workcover Case Managers – Forgetting Ethics?